External validation of the Canadian CT Head Rule and the New Orleans Criteria for CT scanning in patients with minor head injury
External validation of the Canadian CT Head Rule and the New Orleans Criteria for CT scanning in patients with minor head injury
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DOI：
10.1001/jama.294.12.1519
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发表时间：
2005-09-28
影响因子：
120.7
通讯作者：
Hunink, MGM
中科院分区：
文献类型：
--
作者：
Smits, M;Dippel, DWJ;Hunink, MGM
加拿大CT头部规则(CCHR)和新奥尔良标准(NOC)这两个关于轻型颅脑损伤患者CT适应症的决策规则表明，CT扫描可能仅限于具有某些危险因素的患者，这将导致CT扫描的重要减少。目的验证和比较这两个已发表的决策规则在荷兰颅脑损伤患者中的应用。设计、设置和患者一项在2002年2月11日至2004年8月31日期间进行的前瞻性多中心研究，在荷兰的4所大学医院，连续3181名成人轻型颅脑损伤患者出现格拉斯哥昏迷评分(GCS)13~14或GCS评分15且至少有1个危险因素。主要结果指标主要结果是CT扫描上发现的任何脑颅外伤。次要结果是神经外科干预和临床重要的CT表现。结果GCS评分13~15分的3181例患者中，17例(0.5%)接受了神经外科手术治疗，312例(9.8%)患者有颅脑损伤CT表现。神经外科干预对CCHR和NOC的敏感性均为100%。NOC对颅脑损伤和临床重要发现的敏感性(97.7%~99.4%)高于CCHR(83.4%~87.2%)。NOC的特异性很低(3.0%-5.6%)，而CCHR的特异性较高(37.2%-39.7%)。结论对于GCS评分为13~15分的轻型颅脑损伤患者，CCHR对颅脑损伤或临床重要CT征象的敏感性低于NOC，但可以识别所有需要神经外科手术的病例，并具有更大的减少CT扫描的潜力。
Context Two decision rules for indications of computed tomography (CT) in patients with minor head injury, the Canadian CT Head Rule (CCHR) and the New Orleans Criteria (NOC), suggest that CT scanning may be restricted to patients with certain risk factors, which would lead to important reductions in the use of CT scans.Objective To validate and compare these 2 published decision rules in Dutch patients with head injuries.Design, Setting, and Patients A prospective multicenter study conducted between February 11, 2002, and August 31, 2004, in 4 university hospitals in the Netherlands of 3181 consecutive adult patients with minor head injury who presented with a Glasgow Coma Scale (GCS) score of 13 to 14 or with a GCS score of 15 and at least 1 risk factor.Main Outcome Measures Primary outcome was any neurocranial traumatic finding on CT scan. Secondary outcomes were neurosurgical intervention and clinically important CT findings. Sensitivity and specificity were estimated for each outcome for the CCHR and the NOC, using both rules as originally derived and also as adapted to apply to an expanded patient population.Results Of 3181 patients with a GCS score of 13 to 15, neurosurgical intervention was performed in 17 patients (0.5%); neurocranial traumatic CT findings were present in 312 patients (9.8%). Sensitivity for neurosurgical intervention was 100% for both the CCHR and the NOC. The NOC had a higher sensitivity for neurocranial traumatic findings and for clinically important findings (97.7% -99.4%) than did the CCHR (83.4%-87.2%). Specificities were very low for the NOC (3.0%-5.6%) and higher for the CCHR (37.2%-39.7%). The estimated potential reduction in CT scans for patients with minor head injury would be 3.0% for the adapted NOC and 37.3 % for the adapted CCHR.Conclusions For patients with minor head injury and a GCS score of 13 to 15, the CCHR has a lower sensitivity than the NOC for neurocranial traumatic or clinically important CT findings, but would identify all cases requiring neurosurgical intervention, and has greater potential for reducing the use of CT scans.